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New 2021 five-star ratings released—Survey & quality data from 2020 & during the COVID-19 pandemic reflected

Patti Cullen, CAE By Patti Cullen, CAE  |  February 5, 2021  |  Skilled nursing facilities

On January 27, 2021, nursing facility five-star ratings were updated for the first time to reflect quality and survey data during the COVID-19 pandemic and 2020. Five-star ratings were held constant during most of 2020 to prioritize infection control efforts to prevent and mitigate the impact of COVID-19 in nursing facilities. With this latest five-star release, infection control focused survey deficiencies from 2020 were counted as complaint surveys for methodological scoring and rating purposes.

Several quality measures used to determine five-star ratings now reflect data from July 2019 to June 2020 (Q3 2019–Q2 2020). These quality measures reflect a time since March 2020 when visitation from friends and family and social group activities, like communal dinning, were restricted or prohibited by the federal government to prevent and mitigate COVID-19.

Staffing data in this January 2021 release reflects staffing from July 2020 to September 2020 (Q3 2020). This is the second update to five-star ratings with staffing data reflective of data in 2020. Below are highlights from the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).

The overall rating for most nursing homes did not change
Of the 15,340 nursing facilities in the nation, 9,937 (65%) saw no change in their overall rating. Meanwhile, 2,565 (17%) had a decrease of one or more stars and 2,613 (17%) saw an increase in their rating.

Survey and quality ratings also remain similar
Like overall ratings, survey ratings did not change for most nursing homes. Specifically, 11,995 (78%) saw no change in survey rating, while 1,530 (10%) had a decrease of one or more stars and 1,590 (10%) had an increase in their survey rating. Because survey ratings have a fixed distribution within the state, where 10% of nursing facilities get 5-stars, 20% get 1-star, and the rest are evenly split between 2-, 3-, and 4-stars, the lack of significant change in survey star rating is to be expected.

Of the 22 quality measures that were updated to include data through June 2020, the national average showed little absolute change for the vast majority. Only three measures had an absolute change of greater than or equal to one percentage point. Long-stay depression worsened from 5.1% to 6.1%. Long-stay mobility worsened from 17.1% to 18.5%, and short-stay functional improvement improved from 68.0% to 69.0%.

As a result of the efforts since March 2020 to physically distance residents and reduce possible exposure to COVID-19, it is not unexpected to see some quality measures, like depression, worsen. The distribution of quality ratings remained similar in January's release with 61% of nursing homes having either a 4- or 5-star quality rating.

Here is a spreadsheet summary of the impact of these changes on Minnesota nursing facilities:


The latest five-star ratings are available to view by the public on Medicare's “Care Compare” website

For more on the change in five-star ratings, read this brief from the Center for Health Policy Evaluation in Long-Term Care. 

View a summary from AHCA/NCAL and key messages here.  

Patti Cullen, CAE  |  President/CEO  |  |  952-851-2487


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